201
|
Engel R, Chung MT, Johnson J, Stathakios J, Chang ET, Waxman J, Lin HS. Fellow selection protocols in sleep surgery: a national survey of sleep surgery program directors. Sleep Breath 2020; 25:361-364. [PMID: 32557244 DOI: 10.1007/s11325-020-02132-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/06/2020] [Accepted: 06/13/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the factors that sleep medicine/surgery fellowship program directors look for in applicants. METHODS Program directors from 9 sleep medicine/surgery fellowship programs in the USA were sent an anonymous online survey. They were asked to select the five most important academic factors (of a list of 17) when evaluating potential fellowship candidates, then rank those five in order of importance. They were then asked to do the same for the most important subjective criteria (of a list of 12). RESULTS Eight of 10 survey responses met inclusion criteria. Of the academic factors, strength of letters of recommendation, reputation of letter writer, and letters from sleep surgeons ranked highest. As for the subjective criteria, faculty assessment of the applicant on interview was ranked highest, followed by initiative and personality "fit" with the program. The reputation of an applicant's residency was ranked as more important than the reputation of their medical school. An applicant's performance in residency was assessed as more predictive of their performance in fellowship than performance during the interview process or position on the rank order list for the match. Only one program has a United States Medical Licensing Examination (USMLE) Step, and a different program has an Otolaryngology Training Examination (OTE) score cutoff. CONCLUSION Letters of recommendation and interview are the most important factors in the selection process for hybrid sleep medicine and surgery fellowship programs, followed by research and residency program reputation. Sleep surgery-specific experience is helpful.
Collapse
Affiliation(s)
- Ricardo Engel
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Michael T Chung
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA.
| | - Jared Johnson
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - James Stathakios
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Edward T Chang
- Department of Otolaryngology - Head and Neck Surgery, Martin Army Community Hospital, Fort Benning, GA, USA.,Division of Otolaryngology - Head and Neck Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Jonathan Waxman
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| | - Ho-Sheng Lin
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, MI, USA
| |
Collapse
|
202
|
Tseng AS, Fromme HB, Maniscalco J, Jerardi KE, Lockeman KS, Ryan MS. How Do Pediatric Hospital Medicine Fellowships Prepare Graduates as Educators? A Survey of Program Directors and Graduates in the United States. Med Sci Educ 2020; 30:749-765. [PMID: 34457733 PMCID: PMC8368768 DOI: 10.1007/s40670-020-00945-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pediatric hospital medicine (PHM) is the newest recognized subspecialty in pediatrics within the United States. While fellowships in PHM have been available for several years, completion of a 2-year fellowship has become a requirement for subspecialty certification. Pediatric hospitalists provide substantial teaching to trainees, and therefore, PHM fellowships must include dedicated training around teaching and medical education. The purpose of this study was to determine how current PHM fellowships prepare graduates for their roles as medical educators. Two surveys were developed from the published PHM core competencies and Entrustable Professional Activities for pediatric subspecialties. One survey was disseminated to all active PHM program directors and the second was disseminated to all PHM fellowship graduates who completed training between 2012 and 2016. Items included those related to program structure and training/assessment in medical education. A total of 21 program directors (response rate = 58%) and 46 fellowship graduates (response rate = 46%) participated in the survey. All graduates (100%) reported teaching learners in their current setting. Many (67%) fellowship programs offered formal training in medical education, and this is greater than the 50% that was previously described. Direct observation (71%) was the most common method of assessment. Most graduates reported their fellowship provided optimal training in feedback and teaching during family centered rounds but suboptimal training in other skills such as curriculum development. The results of this study highlight areas for improvement in fellowship curriculum and assessment to better prepare fellows for their roles as educators.
Collapse
Affiliation(s)
- Ashlie S. Tseng
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, PO Box 980325, Richmond, VA 23298 USA
| | - H. Barrett Fromme
- Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Jennifer Maniscalco
- Department of Pediatrics, Johns Hopkins-All Children’s Hospital, St. Petersburg, FL USA
| | - Karen E. Jerardi
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Kelly S. Lockeman
- Office of Assessment, Evaluation, and Scholarship, Virginia Commonwealth University School Medicine, Richmond, VA USA
| | - Michael S. Ryan
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, PO Box 980325, Richmond, VA 23298 USA
| |
Collapse
|
203
|
New EP, Sarkar P, Alvero RJ, Imudia AN. Improving the fellowship interview experience for reproductive endocrinology and infertility candidates: a survey. F S Rep 2020; 1:37-42. [PMID: 34223210 PMCID: PMC8244322 DOI: 10.1016/j.xfre.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 03/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To collect data on the current reproductive endocrinology and infertility (REI) fellowship interview process so that it may be improved in the future. DESIGN Web-based cross-sectional survey. In addition, fellowship program directors and coordinators were contacted by e-mail. SETTING Survey data were collected after completion of the 2018 REI fellowship interview season. PATIENTS Not applicable. INTERVENTIONS None. MAIN OUTCOME MEASURES Number of days used for interviews, missed opportunities to interview, frequency of travel to the same city, average money spent, recommendations for how the interview process could be improved. RESULTS There were 44 survey respondents. The mean number of interviews attended was 12.6 (range, 1-22). On average 13.4 (0-30) days off work were used to interview. About 68.1% (n = 30) missed an opportunity to interview at a program they were interested in. The most common reasons were the interview date was the same day as another interview, could not attend due to geographic location, and cost was too high. About 72% (n = 31) traveled to the same city more than once for an interview. The average cost per interview was $478 (range, $200-$1,000) and average cost per interview season was $5,660 (range, $900-$15,000). Fellowship program data were available from 43 of 48 programs contacted. The number of dates that had conflicting interviews scheduled were 26. CONCLUSIONS These data highlight the need to coordinate the REI fellowship recruitment process between programs to reduce conflicting interview dates and mitigate costs to applicants. Based on these results, a concrete action plan is presented.
Collapse
Affiliation(s)
- Erika P New
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Papri Sarkar
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| | - Ruben J Alvero
- Obstetrics & Gynecology, Reproductive Endocrinology and Infertility, Stanford University Medical Center, Sunnyvale, California
| | - Anthony N Imudia
- Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida
| |
Collapse
|
204
|
Savoie KB, Kulaylat AN, Huntington JT, Kelley-Quon L, Gonzalez DO, Richards H, Besner G, Nwomeh BC, Fisher JG. The pediatric surgery match by the numbers: Defining the successful application. J Pediatr Surg 2020; 55:1053-1057. [PMID: 32197826 DOI: 10.1016/j.jpedsurg.2020.02.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pediatric surgery remains the most competitive general surgery subspecialty. The authors suspected significant inflation in academic metrics since the last published paper. This study aimed to identify factors associated with applicant success in the match. METHODS After IRB approval, all applications to a single accredited pediatric surgery fellowship program were reviewed for match years 2014-2018. Matched and unmatched applicants were compared in an unadjusted and adjusted analysis. RESULTS This training program received 414 of 425 total applications (97%). Match results were available for 388 (94%). Matched applicants were more likely to train in programs with pediatric surgery fellowships (64% vs. 28%) and to have dedicated research time (55% vs. 21%; all p < 0.01). Matched applicants had more total publications (median: 12 vs. 7, p < 0.01) and higher ABSITE scores (median: 64th vs. 59th percentile, p < 0.01). Training in multiple programs negatively impacted the chance to match (p < 0.01). The median number of publications per applicant increased over the study time period from 7 to 11 (p < 0.01). CONCLUSIONS The likelihood of matching into a pediatric surgery fellowship was related to the type of residency attended, dedicated research time, ABSITE scores, and number of publications. Overall, the total number of publications reported by all applicants increased. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Kate B Savoie
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Afif N Kulaylat
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Justin T Huntington
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Lorraine Kelley-Quon
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA; Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Dani O Gonzalez
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Holden Richards
- Center for Surgical Outcomes Research, Nationwide Children's Hospital Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Gail Besner
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Benedict C Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
| | - Jeremy G Fisher
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH; Center for Surgical Outcomes Research, Nationwide Children's Hospital Research Institute, Nationwide Children's Hospital, Columbus, OH
| |
Collapse
|
205
|
Keswani A, Brooks JP, Khoury P. The Future of Telehealth in Allergy and Immunology Training. J Allergy Clin Immunol Pract 2020; 8:2135-2141. [PMID: 32426217 PMCID: PMC7233253 DOI: 10.1016/j.jaip.2020.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 11/13/2022]
Abstract
With emerging interest in the use of telemedicine, allergy-immunology should be at the forefront of adoption and implementation of these services. Patients report a greater desire for telemedicine services as well as satisfaction with video-based visits with their providers. Interim virtual visits can accommodate overscheduled clinics, reduce burdens of travel to distant sites, improve access to subspecialty care, and increase adherence during monitoring of chronic allergic conditions. The outpatient nature of allergy-immunology coupled with the ease of conducting many aspects of a routine visit via telemedicine makes the incorporation of telehealth training into fellowship programs highly desirable. The short-term closure of hospital-affiliated clinics, in particular, for vulnerable or immunodeficient patients, in the setting of a global pandemic demonstrates the timeliness of this topic. A framework for implementing telemedicine into the allergy-immunology curriculum, training faculty on appropriate supervision, providing elective clinical experience in the form of continuity clinics, and simulating telemedicine delivery is discussed. Proposed telemedicine competencies desired for the independent practice of telemedicine are suggested.
Collapse
Affiliation(s)
- Anjeni Keswani
- Division of Allergy/Immunology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Joel P Brooks
- Division of Allergy/Immunology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; Division of Allergy and Immunology, Children's National Hospital, Washington, DC
| | - Paneez Khoury
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.
| |
Collapse
|
206
|
Zychowicz ME. A Day in the Life: Advanced Practice Nurses Providing Care to Patients with Musculoskeletal Conditions: Preparation, Role, and Impact. Nurs Clin North Am 2020; 55:163-174. [PMID: 32389251 DOI: 10.1016/j.cnur.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurse practitioners (NPs) play an increasingly greater role in the delivery of orthopedic patient care. NPs practice in a wide variety of orthopedic settings having a significant positive impact on orthopedic care delivery. Few formal educational outlets exist for training NPs for orthopedic care. Many new orthopedic NPs rely on continuing education and an apprenticeship model of learning "on the job" with their surgeon counterparts. This article describes the preparation, role, and impact that today's NPs have on orthopedic care delivery.
Collapse
Affiliation(s)
- Michael E Zychowicz
- Orthopedic NP Specialty, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA.
| |
Collapse
|
207
|
Vey BL, Cook TS, Nagy P, Bruce RJ, Filice RW, Wang KC, Safdar NM. A Survey of Imaging Informatics Fellowships and Their Curricula: Current State Assessment. J Digit Imaging 2020; 32:91-96. [PMID: 30374655 DOI: 10.1007/s10278-018-0147-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In a 2016 survey of imaging informatics ("II") fellowship graduates, the surveyed fellowship graduates expressed the "opinion that II fellowships needed further formalization and standardization" Liao et al. (J Digit Imaging, 2016). This, coupled with the fact that the original published "standardized" curriculum is about 15 years out of date in our rapidly changing systems, suggests an opportunity for curriculum improvement. Before agreeing on improved structural and content suggestions for fellowships, we completed a current-state assessment of how each fellowship organizes its education and what requirements each have for fellowship completion. In this work, we aimed to collect existing information about imaging informatics fellowship curricula by contacting institutions across the country. A survey was completed by phone with the fellowship directors of existing imaging informatics fellowships across the country. Additionally, we collected existing documentation that outlines the curricula currently in use at institutions. We reviewed both the interview responses and documentation to assess overlapping trends and institutional differences in curriculum structure and content. All fellowships had suggested reading lists, didactic lectures, and a required project for each fellow. There were required practicum activities or teaching experience each in two fellowships, and one fellowship had a mandatory certification requirement for graduation. Curriculum topics in Technical Informatics or Business and Management were covered by a majority of institutions, while Quality and Safety and Research topics had inconsistent coverage across fellowships. Our plan is to reengage II fellowship directors to develop a core curriculum, which is part of the Society of Imaging Informatics in Medicine strategic plan.
Collapse
Affiliation(s)
- Brianna L Vey
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA.
| | - T S Cook
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - P Nagy
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, USA.,Division of Health Science Informatics, Johns Hopkins University School of Public Health, Baltimore, USA
| | - R J Bruce
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - R W Filice
- Department of Radiology, Medstar Georgetown University Hospital, Washington D.C., USA
| | - K C Wang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, Baltimore, USA
| | - N M Safdar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, USA
| |
Collapse
|
208
|
Abstract
Post-graduate training for physicians involves a high level of stress. High stress during training has the potential to cause burnout, a well-studied phenomenon in medical trainees. Burnout has previously been shown to increase the risk of mental health problems and medical error in trainees. Little research has been done on the impact of stress on new fellows in general and pediatric cardiology fellows in particular; understanding common sources of stress offers the opportunity to design targeted interventions to support trainee wellness. New trainees in Boston Children's Hospital's Pediatric Cardiology Fellowship program were asked to answer to the following question at the beginning of their training: "What are you afraid of in the coming year?" A qualitative content analysis was done on their anonymous responses. Responses were coded and analyzed for common themes. The overall analysis found that 83% of fellows reported fear of "fellowship/career responsibilities." The second most common theme was "failure/disappointment" (78%) followed by "personal life" (74%), "emotional exhaustion" (61%); least common was "new hospital environment" (37%). The most common individual fear was "increased clinical responsibility" reported by 65% of the new fellows, while 62% reported fears of "imposter syndrome," and 58% about "burnout." We found that fellows commonly report fears about both clinical and personal responsibilities, similar to stressors found in studies on residency. It is important for pediatric cardiology fellowships to develop early and specific interventions designed to assist fellows in managing both their new clinical responsibilities and their other stressors.
Collapse
Affiliation(s)
- David W Brown
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
| | - Geoffrey Binney
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Zachary Gauthier
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| |
Collapse
|
209
|
Dyhdalo KS, Oshilaja O, Chute DJ, Booth CN, Suchy P, Smith K, Procop GW, Reynolds JP. Cytopathology milestones: can you get to level 5? J Am Soc Cytopathol 2020; 9:242-248. [PMID: 32340924 DOI: 10.1016/j.jasc.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION ACGME Milestones describe 6 areas of proficiency, indicating readiness for practice. Each is divided into 5 levels of mastery; Level 1 (new trainees) through Levels 4 (graduation) and 5 (aspirational). Milestones reporting began Spring 2016. We used Milestones to assess graduated fellows. MATERIALS AND METHODS We conducted phone interviews with previous fellows and collected demographic information including practice setting. We asked graduates if they fulfilled each example of mastery and recorded their answers. RESULTS A total of 22 fellows graduated from 2010 to 2017; 15 responded (10 academic, 5 private). Milestones in which nearly all respondents performed well (Level 4+) were: PC1, MK1, SBP2, SBP4, PROF1-4, ICS1-3. Some were more challenging (PC2, MK2, SBP1/3/5, PBL1). For PC2, 2 respondents achieved Level 1 (did not perform fine-needle aspirations). For MK2, 2 respondents achieved Level 1 (did not evaluate Papanicolaou). For SBP1, 80% in private practice achieved Level 5; 50% in academics achieved Level 3. For SBP3, 80% in private practice achieved Level 4+; 100% in academics achieved maximum Level 2. For SBP5, 60% of all respondents achieved maximum Level 3; only 1 achieved Level 5. CONCLUSIONS Many Milestones are attainable. Eleven of 18 yielded Level 4+ from most respondents. Three (PC2, MK1, MK2) yielded rare Level 1 due to scope of practice. Others (SBP1, SBP3) reflect more of an all-or-nothing phenomenon. For SBP5, most respondents achieved Level 3; only 1 achieved Level 5. Some Milestones are highly dependent on practice setting, and others remain aspirational.
Collapse
Affiliation(s)
- Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Olaronke Oshilaja
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah J Chute
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Suchy
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kristen Smith
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
210
|
Burleson SL, Pigott DC, Gullett JP, Greene C, Gibson CB, Irvine S, Kaminstein D. Point-of-care ultrasound in resource-limited settings: the PURLS fellowship. Ultrasound J 2020; 12:14. [PMID: 32193724 PMCID: PMC7082434 DOI: 10.1186/s13089-020-00159-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/06/2020] [Indexed: 01/21/2023] Open
Abstract
Background The role of point-of-care ultrasonography (POCUS) is rapidly expanding in both resource-rich and resource-limited settings (RLS). One limitation to this rapid expansion has been the lack of educators adequately trained to teach this user-dependent skill. This is particularly true in RLS, where disease presentations, infrastructure limitations, and approach to medical education present unique challenges to the direct application of resource-rich emergency department POCUS curricula. Objectives We describe the point-of-care ultrasound in resource-limited settings (PURLS) fellowship, a novel curriculum designed to provide advanced training and expertise in clinical care and POCUS application and education in RLS. Conclusion Our curriculum design is one approach to create context-specific POCUS education for use in RLS, thereby improving patient care.
Collapse
Affiliation(s)
- Samuel L Burleson
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA.
| | - David C Pigott
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - John P Gullett
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Christopher Greene
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Courtney B Gibson
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Scott Irvine
- Department of Emergency Medicine, University of Alabama at Birmingham Hospital, Old Hillman Building Suite 251, 619 19th St S, Birmingham, AL, 35249, USA
| | - Daniel Kaminstein
- Department of Emergency Medicine, Augusta University, Augusta, GA, USA
| |
Collapse
|
211
|
Emejulu JK, Malomo A, Oremakinde A, Onyia C, Nwaribe E, Ekweogwu O, Oseni A, Opara O, Iroegbu-Emeruem L, Otorkpa E, Komolafe E, Bankole O, Shehu B. Developing a Guideline for Neurotrauma in Nigeria. World Neurosurg 2020; 138:e705-e711. [PMID: 32179184 DOI: 10.1016/j.wneu.2020.03.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/06/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Nigerian Academy of Neurological Surgeons in 2019 resolved to standardize the practice of neurosurgery in Nigeria. It set up committees to standardize the various aspects of neurosurgery, such as neurotrauma, pediatrics, functional, vascular, skull base, brain tumor, and spine. The Committee on Neurotrauma convened and resolved to study most of the available protocols and guidelines in use in different parts of the world. OBJECTIVE To formulate a standard protocol for the practice of neurotrauma care within the Nigerian locality. METHODS The Committee split its membership into 3 subcommittees to cover the various aspects of the Neurotrauma Guidelines, such as neurotrauma curriculum, standard neurotrauma management protocols, and neurotrauma registry. Each subcommittee was to research on available models and formulate a draft for Nigerian neurotrauma. RESULTS All the 3 subcommittees had their reports ready on schedule. Each concurred that neurotrauma is a major public health challenge in Nigeria. They produced 3 different drafts on the 3 thematic areas of the project. The subcommittees are: 1. Subcommittee on Fellowship, Training and Research Curriculum; 2. Subcommittee on Standard Protocols and Management Guidelines; and 3. Subcommittee of the Nigerian Neurotrauma Registry. CONCLUSION The committee concluded that a formal protocol for neurotrauma care is long overdue in Nigeria for the standardization of all aspects of neurotrauma. It then recommended the adoption of these guidelines by all institutions offering services in Nigeria using the management protocols, opening a registry, and mounting researches on the various aspects of neurotrauma.
Collapse
Affiliation(s)
- Jude-Kennedy Emejulu
- Department of Surgery, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Adefolarin Malomo
- Department of Neurosurgery, University College Hospital and College of Medicine, Ibadan, Nigeria
| | | | - Chiazor Onyia
- Department of Surgery, Lagoon hospitals, Lagos, Nigeria
| | | | - Ofodile Ekweogwu
- Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Abidemi Oseni
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwamayowa Opara
- Neurosurgery Unit, Regions Stroke and Neurosciences Hospital, Owerri, Nigeria
| | - Linda Iroegbu-Emeruem
- Department of Surgery, University of Port Harcourt Teaching Hospital, Choba, Nigeria
| | - Ega Otorkpa
- Department of Surgery, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Edward Komolafe
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olufemi Bankole
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Bello Shehu
- Department of Surgery, National Hospital, Abuja, Nigeria
| |
Collapse
|
212
|
Adair T, Richards N, Streatfield A, Rajasekhar M, McLaughlin D, Lopez AD. Addressing critical knowledge and capacity gaps to sustain CRVS system development. BMC Med 2020; 18:46. [PMID: 32146902 PMCID: PMC7061462 DOI: 10.1186/s12916-020-01523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/11/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Improving civil registration and vital statistics (CRVS) systems requires strengthening the capacity of the CRVS workforce. The improvement of data collection and diagnostic practices must be accompanied by efforts to ensure that the workforce has the skills and knowledge to assess the quality of, and analyse, CRVS data using demographic and epidemiological techniques. While longer-term measures to improve data collection practices must continue to be implemented, it is important to build capacity in the cautious use of imperfect data. However, a lack of training programmes, guidelines and tools make capacity shortages a common issue in CRVS systems. As such, any strategy to build capacity should be underpinned by (1) a repository of knowledge and body of evidence on CRVS, and (2) targeted strategies to train the CRVS workforce. MAIN TEXT During the 4 years of the Bloomberg Philanthropies Data for Health (D4H) Initiative at the University of Melbourne, an extensive repository of knowledge and practical tools to support CRVS system improvements was developed for use by various audiences and stakeholders (the 'CRVS Knowledge Gateway'). Complementing this has been a targeted strategy to build CRVS capacity in countries that comprised two approaches - in-country or regional training and a visiting Fellowship Program. These approaches address the need to build competence in countries to collect, analyse and effectively use good quality birth and death data, and a longer-term need to ensure that local staff in countries possess the comprehensive knowledge of CRVS strategies and practices necessary to ensure sustainable CRVS development. CONCLUSION The Knowledge Gateway is a dynamic, useful and long-lasting repository of CRVS knowledge for countries and development partners to use to formulate and evaluate CRVS development strategies. Capacity-building through in-country or regional training and the University of Melbourne D4H Fellowship Program will ensure that CRVS capacity and knowledge is developed and maintained, facilitating improvements in CRVS data systems that can be used by policymakers to support better decision-making in health.
Collapse
Affiliation(s)
- Tim Adair
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia.
| | - Nicola Richards
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Avita Streatfield
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Megha Rajasekhar
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Deirdre McLaughlin
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| | - Alan D Lopez
- Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, 3053, Australia
| |
Collapse
|
213
|
Cho EE, Maruyama K, Hutter M, Osman H, Jeyarajah DR. Advanced Gastrointestinal Surgery Fellowship Graduates Are Desirable to Current US General Surgery Practices: Results of a SSAT Sponsored Survey. J Gastrointest Surg 2020; 24:695-700. [PMID: 30941688 DOI: 10.1007/s11605-019-04208-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/08/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Fellowship training after surgery residency has become commonplace. The concept of an advanced gastrointestinal (AGI) surgical fellowship has been implemented through the SSAT and Fellowship Council (FC). Newer and more competitive requirements are being proposed through a taskforce inclusive of many surgical societies. This study was designed to measure the interest in hiring graduates of AGI fellowship. METHOD This is a SSAT sponsored 20-question survey which was sent out to the Society members in general surgery practices (mix of hospital based and private) across the USA through an online electronic survey software (SurveyMonkey, Palo Alto, Ca.). Descriptive statistics were generated from aggregate survey responses. RESULTS We had a total of 285 responses. Majority (92%) preferred hiring a surgeon who has completed a post-graduate fellowship. Type of fellowship preferred by the prospective employers varied depending on the focus and the need of the individual practice. Most important characteristic that the employers sought were references, letters of recommendation, and work ethic, followed by technical skills, and completion of fellowship. Most of the responders felt that a complex GI surgery fellowship may be an attractive qualification in prospective job candidates. CONCLUSION Our survey showed that the majority of surgery practices in the US prefer fellowship-trained candidates as potential hires. Only a small minority (< 20%) of those surveyed felt that completing an AGI fellowship would not give prospective candidates an advantage in obtaining a job. Our results indicate a growing need for a AGI surgery fellowship.
Collapse
|
214
|
Ngaage LM, Kim CJ, Harris C, McNichols CH, Ihenatu C, Rosen C, Elegbede A, Gebran S, Liang F, Rada EM, Nam A, Slezak S, Lifchez SD, Rasko YM. Graduate perception of cosmetic surgery training in plastic surgery residency and fellowship programs. Arch Plast Surg 2020; 47:70-7. [PMID: 31964126 DOI: 10.5999/aps.2019.00409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 11/23/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND As the demand for cosmetic surgery continues to rise, plastic surgery programs and the training core curriculum have evolved to reflect these changes. This study aims to evaluate the perceived quality of current cosmetic surgery training in terms of case exposure and educational methods. METHODS A 16-question survey was sent to graduates who completed their training at a U.S. plastic surgery training program in 2017. The survey assessed graduates' exposure to cosmetic surgery, teaching modalities employed and their overall perceived competence. Case complexity was characterized by the minimum number of cases needed by the graduate to feel confident in performing the procedure. RESULTS There was a 25% response rate. The majority of respondents were residents (83%, n=92) and the remaining were fellows (17%, n=18). Almost three quarters of respondents were satisfied with their cosmetic training. Respondents rated virtual training as the most effective learning modality and observing attendings' patients/cases as least effective. Perceived competence was more closely aligned with core curriculum status than case complexity, i.e. graduates feel more prepared for core cosmetic procedures despite being more technically difficult than non-core procedures. CONCLUSIONS Despite the variability in cosmetic exposure during training, most plastic surgery graduates are satisfied with their aesthetic training. Incorporation of teaching modalities, such as virtual training, can increase case exposure and allow trainees more autonomy. The recommended core curriculum is adequately training plastic surgery graduates for common procedures and more specialized procedures should be consigned to aesthetic fellowship training.
Collapse
|
215
|
Ernat JJ, Yheulon CG, Lopez AJ, Warth LC. Does the h-index and self-citation affect external funding of orthopedic surgery research? An analysis of fellowship directors and their subspecialties. J Orthop 2020; 20:92-96. [PMID: 32042236 DOI: 10.1016/j.jor.2020.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/19/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose Determine the impact of self-citation on external funding for orthopedic fellowship directors. Methods The San Francisco Match's website identified directors encompassing 8 subspecialties. The Scopus database identified the number of publications, citations, and h-index for each director. H-index was assessed with/without self-citation. Results Mean publications, citations, self-citation rate, and h-index for the 446 directors were 71.2, 1816, 3.86%, and 18.3, respectively. Excluding self-citations reduces mean h-index to 18.0; and h-index changed by ≤ 1 integer in 95% of directors. Conclusions Self-citation has minimal impact among fellowship directors and should not be adjusted for when considering external funding.
Collapse
Affiliation(s)
- Justin J Ernat
- Staff Orthopaedic Surgeon, Department of Orthopaedic Surgery, Blanchfield Army Community Hospital, 650 Joel Dr, Fort Campbell, KY, 42223, United States
| | - Christopher G Yheulon
- Staff General Surgeon, Department of Surgery, Tripler Army Medical Center, 1 Jarrett White Rd., Honlulu, HI, 96859, United States
| | - Andrew J Lopez
- Resident Orthopedic Surgeon, Tripler Army Medical Center, 1 Jarrett White Rd., Honolulu, HI, 96859, United States
| | - Lucian C Warth
- Staff Orthopaedic Arthroplasty Surgeon, Indiana University School of Medicine, Assistant Clinical Professor of Orthopaedic Surgery, 340 W 10th St #6200, Indianapolis, IN, 46202, United States
| |
Collapse
|
216
|
Harbaugh CM, Fischer BA, Lawrence AE, Halleran DR, Thomas LN, Kim R, Deans KJ, Minneci PC, Sandhu G, Hirschl RB. Caregiver knowledge, opinion, and willingness to consent to trainee involvement in pediatric surgical care. J Pediatr Surg 2020; 55:112-116. [PMID: 31699435 DOI: 10.1016/j.jpedsurg.2019.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/29/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Surgical training is shifting toward competency-based models that promote earlier supervised autonomy. We assessed caregiver knowledge, willingness to consent, and opinions regarding trainee autonomy in their child's operation. METHODS At two academic children's hospitals, 100 caregivers of children aged 0-17 years completed an electronic survey in the pediatric surgery clinic (1/2018-4/2018). Knowledge, willingness to consent, and opinions of trainee involvement in their child's operation in standard and competency-based training models were assessed. McNemar's test compared willingness to consent with standard and competency-based training (p < 0.05). RESULTS Caregivers were 75% female, 41% age 30-39 years old, and 78% white. All provider roles were correctly identified by 14% of caregivers. For routine procedures, caregivers would consent to a fellow assisting (95%) or independently operating with the attending present (78%). They would less likely consent if the attending was not in the operating room (39%) or the hospital (25%). Competency-based training improved willingness to consent, but was significant only for independence with the attending present. Most caregivers wanted to know about (81%) and be asked permission for (82%) trainee involvement in their child's operation. CONCLUSIONS This study suggests that surgeons in academic settings must balance transparency with trainee autonomy when obtaining caregiver consent. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
| | - Beth A Fischer
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Amy E Lawrence
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Devin R Halleran
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Loren N Thomas
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Rylee Kim
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Gurjit Sandhu
- Department of Surgery, University of Michigan, Ann Arbor, MI; Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI
| | - Ronald B Hirschl
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| |
Collapse
|
217
|
Marshall AL, Gupta R, Grill D, Mann S, Freidline K, Nowakowski G, Thompson C, Hobday T. Identification of Factors Associated with Hematology-Oncology Fellow Academic Success and Career Choice. J Cancer Educ 2019; 34:1219-1224. [PMID: 30267295 DOI: 10.1007/s13187-018-1432-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Factors affecting hematology-oncology trainees' academic success and career choices have not been well characterized. We performed a retrospective study of 57 hematology-oncology fellows trained at Mayo Clinic between 2008 and 2017 in an attempt to identify factors associated with success during fellowship and with career choice (academic versus private). Sex, age, residency quality, and letters of recommendation indicating a "top" applicant were not associated with hematology or oncology in-training examination (ITE) scores, research productivity (abstracts/publications during fellowship), or career choice (academic versus private). Fellows with higher United States Medical Licensing Examination (USMLE) scores were more likely to perform well on ITE, but examination scores did not predict academic productivity or academic versus private career choice. More academically productive fellows were more likely to choose academic careers. Both ITE scores and productivity were associated with receipt of national and/or institutional awards. Finally, fellows who were non-US citizens and/or international medical graduates (IMG) had higher academic productivity both pre-fellowship and during fellowship and as per the observations above were more likely to choose academic careers. In conclusion, predictors of superior knowledge differ from predictors of academic productivity/career choice, and it is important to take multiple factors into account when selecting candidates most likely to succeed during fellowship.
Collapse
Affiliation(s)
- Ariela L Marshall
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruchi Gupta
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Diane Grill
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Susan Mann
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kimberly Freidline
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Grzegorz Nowakowski
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carrie Thompson
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Mayo Building 10th floor, 10-90E, 200 First Street SW, Rochester, MN, 55905, USA
| | | |
Collapse
|
218
|
Milburn JM, Heitkamp DE, Jay AK, Sarkany D, Ali K, DeBenedectis CM, England E, Ho CP, Kalia V, Kumm TR, Ong S, Paladin AM, Patel MD, Swanson JO, Hirsch JA. Should Radiology Delay the Start of Fellowships? A Survey of the APDR. Acad Radiol 2019; 26:1550-1554. [PMID: 31047793 DOI: 10.1016/j.acra.2019.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 03/25/2019] [Accepted: 03/31/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES Several major medical specialties have recently considered delaying the start date of their fellowship training programs to allow for completion of their trainees' residency obligations. Radiology program directors (PDs) have voiced the need for a similar solution, as fellowship start dates at some institutions now occur well before the end of residency training. The objectives of this study are to assess the current state of the radiology fellowship transition and understand its impact on residency programs and clinical services. MATERIALS AND METHODS Survey Monkey (Palo Alto, CA) was used to create a survey consisting of 9 multiple choice and 2 free text questions. The survey was approved by the survey committee of the Association of Program Directors in Radiology (APDR) and distributed via email to all 240 APDR members in November 2018. The survey was closed after 30 days. RESULTS The response rate was 67% (160/240). Fifty-nine percent of respondents indicated some of their residents are asked to arrive at fellowships before July 1, often several days early for orientation and picture archiving and communication system (PACS) training. Sixteen percent of respondents said their own institutions ask incoming fellows to arrive early. Sixty-four percent of respondents indicated that this causes staffing problems. Seventy-eight percent of respondents supported considering a delay to the start of radiology fellowships. CONCLUSION Most APDR members claim that residents are asked to arrive at fellowships early to complete orientation and training before July 1, and most say that this produces staffing problems on services. A significant majority of respondents support a discussion regarding delaying fellowship start dates.
Collapse
Affiliation(s)
| | - Darel E Heitkamp
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Ann K Jay
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - David Sarkany
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Kamran Ali
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | | | - Eric England
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Christopher P Ho
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Vivek Kalia
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Todd R Kumm
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Seng Ong
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Angelisa M Paladin
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Maitray D Patel
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Jonathan O Swanson
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| | - Joshua A Hirsch
- Ochsner Health System, Radiology, 1413 Jefferson Highway, New Orleans, LA
| |
Collapse
|
219
|
Hoffman MS, Xiong Y, Apte S, Roberts W, Wenham RM. Twenty-year surgical trends in a gynecologic oncology fellowship training program: Implications for practice. Gynecol Oncol 2019; 155:359-364. [PMID: 31575391 DOI: 10.1016/j.ygyno.2019.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether there were any significant changes in surgical training volume over the past 20 years that might have ramifications toward preparedness for practice. METHODS We used deidentified annual summaries of fellow case numbers for the academic years 1999 through 2018. Unpaired t-tests with Welch's correction were performed on all surgical categories for 10-year and 5-year periods. RESULTS The total number of hysterectomies performed each year did not change significantly. The percent of hysterectomies performed by minimally invasive surgery increased significantly starting in 2008. There was a significant decline in the number of radical hysterectomies conducted starting after 2004, which then remained stable. There was also a significant decline in the number of bowel resections/anastomoses performed by fellows on the gynecologic oncology services that occurred and stabilized during the same time frame. There were other significant trends associated with the introduction of minimally invasive techniques. CONCLUSION The results of this study suggest the need to reevaluate fellowship training and/or the scope of surgical practice in gynecologic oncology.
Collapse
Affiliation(s)
- Mitchel S Hoffman
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; The University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Yin Xiong
- Department of Biostatistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Sachin Apte
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; The University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - William Roberts
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; The University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Robert M Wenham
- Department of Gynecologic Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; The University of South Florida Morsani College of Medicine, Tampa, FL, USA
| |
Collapse
|
220
|
Farmakis SG, Hardy AK, Thomas KB, Lampl BS, McDaniel JD, Bowling RH. Changes in factors influencing fellowship choices among radiology residents from 2008 to 2018 and methods that may increase interest in the pediatric radiology subspecialty. Pediatr Radiol 2019; 49:1132-1141. [PMID: 31165184 DOI: 10.1007/s00247-019-04430-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/16/2019] [Accepted: 05/15/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Fewer residents are choosing a career in pediatric radiology, which is contributing to an ongoing shortage of pediatric radiologists. OBJECTIVE To identify potential causes of reduced interest in pediatric radiology as a career given a projected worsening of a nationwide shortage of pediatric radiologists. MATERIALS AND METHODS An online questionnaire using previously published questions was approved and distributed by the Program Directors in Diagnostic Radiology to diagnostic radiology residents on behalf of the Society for Pediatric Radiology (SPR). Descriptive statistics including means with standard error and independent t-tests were used to compare mean scores between survey years. RESULTS Nearly all of the 353 respondents (90.9%) planned on pursuing a fellowship. The majority (57.7%) identified their fellowship subspecialty before the 3rd year of residency with only 5.7% selecting pediatric radiology. Overall, 18.2% of survey respondents favored academic practice compared to 40% in the pediatric radiology subgroup. Fellowship choices were most strongly based on area of strong personal interest, marketability and area of strong personal knowledge, while the pediatric radiology subgroup emphasized area of strong personal interest, increased interaction with other physicians and enjoyable residency rotations. The pediatric radiology subgroup believed their impact on patient care was more significant than other subspecialties. Pediatric radiology job opportunities were thought to be more limited, geographically confining, and to have lower salaries than other subspecialties. More flexible job opportunities and higher demand were identified as factors needing to change before a resident would consider a pediatric radiology career. CONCLUSION The influence on fellowship selection is multifactorial. By emphasizing the favorable job market and marketability of pediatric radiology in all practice types/geographic locations, correcting perceived salary gaps and stressing the impact on patient care as early as medical school, the number of residents choosing a career in pediatric radiology may grow.
Collapse
Affiliation(s)
- Shannon G Farmakis
- Department of Radiology, SSM Health Cardinal Glennon Children's Hospital, St. Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA.
| | - Anna K Hardy
- Department of Radiology, St. Louis University School of Medicine, St. Louis, MO, USA
| | | | | | | | - Rebecca Hulett Bowling
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
221
|
Tso MK, Max Findlay J, Lownie SP, Chris Wallace M, Toyota BD, Fleetwood IG. Recent Trends in Neurosurgery Career Outcomes in Canada. Neurol Sci 2019; 46:436-42. [PMID: 31010443 DOI: 10.1017/cjn.2019.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND As with other specialties, Royal College of Physicians and Surgeons of Canada (RCPSC) trainees in Neurosurgery have anecdotally had challenges securing full-time employment. This study presents the employment status, research pursuits, and fellowship choices of neurosurgery trainees in Canadian programs. METHODS RCPSC neurosurgery trainees (n = 143) who began their residency training between 1998 and 2008 were included in this study. Associations between year of residency completion, research pursuits, and fellowship choice with career outcomes were determined by Fisher's exact test (p < 0.05, statistical significance). RESULTS In 2015, 60% and 26% of neurosurgery trainees had permanent positions in Canada and the USA, respectively. Underemployment, defined as locum and clinical associate positions, pursuit of multiple unrelated fellowships, unemployment, and career change to non-surgical career, was 12% in 2015. The proportion of neurosurgery trainees who had been underemployed at some point within 5 years since residency completion was 20%. Pursuit of in-folded research (MSc, PhD, or non-degree research greater than 1 year) was significantly associated with obtaining full employment (94% vs. 73%, p = 0.011). However, fellowship training was not significantly associated with obtaining full employment (78% vs. 75%, p = 1.000). CONCLUSIONS Underemployment in neurosurgery has become a significant issue in Canada for various reasons. Pursuit of in-folded research, but not fellowship training, was associated with obtaining full employment.
Collapse
|
222
|
Okhunov Z, Safiullah S, Patel R, Juncal S, Garland H, Khajeh NR, Martin J, Capretz T, Cottone C, Jordan ML, McDougall E, Clayman RV, Landman J. Evaluation of Urology Residency Training and Perceived Resident Abilities in the United States. J Surg Educ 2019; 76:936-948. [PMID: 30803721 DOI: 10.1016/j.jsurg.2019.02.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/17/2018] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify differences and potential deficiencies in urology residency training programs in the United States as they are perceived by residents/recent graduates and program directors. MATERIALS AND METHODS A 45-question and 38-question survey was sent to chief residents/recent graduates and program directors, respectively, at all 120 US urology programs regarding prior medical education, urologic training curricula, and perceived surgical proficiency, among other topics. RESULTS Survey response rate was 58% and 52% for residents and program directors, respectively. Responses regarding program characteristics (e.g., salary, vacation) and research training were similar between program directors and residents. However, their responses regarding skills training and subspecialty training (e.g., robotics and pediatrics) differed substantially. Program directors reported the availability of advanced skills trainers (robot-88%, laparoscopic-86%), whereas fewer residents felt they were available (robot 54% and laparoscopic 72%). The same discrepancies persisted with questions about subspecialty exposure (e.g., program directors reported 48% renal transplant experience vs. 13% reported by residents). Most residents felt comfortable performing essential urology procedures (e.g., cystoscopy/ureteroscopy, open nephrectomy). In contrast, the majority expressed a lack of confidence in performing unsupervised advanced minimally invasive procedures (e.g., laparoscopic and robotic partial nephrectomy, endopyelotomy). Among the responding residents, 72% pursued fellowship training; nearly two-thirds of these residents chose to enter fellowship in order to overcome perceived training deficiencies. CONCLUSIONS Program directors and residents have differing perceptions regarding the education and resources associated with US urology residency training programs. US graduates of urology residency programs express a perceived lack of confidence in several procedures that are commonly encountered in a general urologic practice.
Collapse
Affiliation(s)
- Zhamshid Okhunov
- Department of Urology, University of California, Irvine, Orange, California.
| | - Shoaib Safiullah
- Department of Urology, University of California, Irvine, Orange, California
| | - Roshan Patel
- Department of Urology, University of California, Irvine, Orange, California
| | - Samuel Juncal
- Department of Urology, University of California, Irvine, Orange, California
| | - Harwood Garland
- Department of Urology, University of California, Irvine, Orange, California
| | - Nikta R Khajeh
- Department of Urology, University of California, Irvine, Orange, California
| | - Jeremy Martin
- Department of Urology, University of California, Irvine, Orange, California
| | - Taylor Capretz
- Department of Urology, University of California, Irvine, Orange, California
| | - Courtney Cottone
- Department of Urology, University of California, Irvine, Orange, California
| | - Mark L Jordan
- Department of Urology, University of California, Irvine, Orange, California
| | - Elspeth McDougall
- University of British Columbia, Gordon and Leslie Diamond Health Care Centre, Vancouver, British Columbia, Canada
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| |
Collapse
|
223
|
Weis JJ, Alseidi AA, Jeyarajah DR, Schweitzer MA, Hori Y, Cheung V, Scott DJ. Providing complex GI surgical care with minimally invasive approaches: a survey of the practice patterns of Fellowship Council alumni. Surg Endosc 2019; 34:1776-1784. [PMID: 31209609 DOI: 10.1007/s00464-019-06929-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The Fellowship Council (FC) oversees 172 non-ACGME surgical fellowships offering 211 fellowship positions per year. These training programs cover multiple specialties including Advanced gastrointestinal (GI), Advanced GI/MIS, Bariatric, Hepatopancreaticobiliary (HPB), Flexible Endoscopy, Colorectal, and Thoracic Surgery. Although some data have been published detailing the practice environments (i.e., urban vs. rural) and yearly total case volumes of FC alumni, there is a lack of granular data regarding the practice patterns of FC graduates. The aim of this study was to gather detailed data on the specific case types performed and surgical approaches employed by recent FC alumni. METHODS A 21-item survey covering 64 data points was emailed to 835 FC alumni who completed their fellowship between 2013 and 2017. Email addresses were obtained from FC program directors and FC archives. RESULTS We received 327 responses (39% response rate). HPB, Advanced Colorectal, and Advanced Thoracic alumni appear to establish practices focused on their respective fields. Graduates from Advanced GI, Adv GI/MIS, and Bariatric programs appear to build practices with a mix of several complex GI case types including bariatrics, colorectal, foregut, HPB, and hernia cases. CONCLUSIONS This is the first large data set to provide granular information on the practice patterns of FC alumni. FC trained surgeons perform impressive volumes of complex procedures, and minimally invasive approaches are extremely prevalent in these practices. Further, many graduates carve out practices with large footprints in robotics and endoscopy.
Collapse
Affiliation(s)
- Joshua J Weis
- University of Texas Southwestern Medical Center, Dallas, TX, USA. .,University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Ste. E6.200, Dallas, TX, 75390-9092, USA.
| | | | | | | | - Yumi Hori
- The Fellowship Council, Los Angeles, CA, USA
| | | | - Daniel J Scott
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
224
|
Weis JJ, Goldblatt M, Pryor A, Schultz L, Scott DJ. SAGES Advanced GI/MIS fellowship redesign: pilot results and adoption of new standards. Surg Endosc 2019; 33:3056-61. [PMID: 31190226 DOI: 10.1007/s00464-019-06899-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION SAGES is responsible for defining educational content for Advanced GI/MIS fellowships administered through the fellowship council (FC). In Fall 2016, to better define core content contained in these fellowships, SAGES proposed new case log criteria including minimum volumes within six defined categories. To test feasibility of these criteria, SAGES conducted a pilot study during the 2017-2018 academic year. METHODS Advanced GI/MIS fellowship programs directors (PD's) who also held leadership roles in SAGES were invited to participate in the pilot. Fourteen programs including 17 fellows volunteered. To assess generalizability, 2016-2017 case log data for the volunteered pilot programs were compared to all other advanced GI/MIS programs (n = 92). To assess feasibility of the new criteria, pilot programs' 2017-2018 case logs were compared to 3 years of historical fellows' case logs (n = 326). Fisher's exact test was used for comparisons with p < 0.05 considered significant. RESULTS Complete data were available for 16 pilot fellows (median 251.5 advanced MIS cases and 62.5 endoscopies per fellow). According to 2016-2017 data, pilot programs were not statistically different from non-pilot programs regarding achievement of any defined category minimum. Compared to historical controls, the 2017-2018 pilot fellows were significantly more likely to meet the defined category minimum for foregut cases and demonstrated a non-significant trend toward higher achievement of minimums for bariatrics, inguinal hernia, ventral hernia, and endoscopy. Pilot fellows were significantly less likely to meet the minimum for HPB/solid organ/colorectal/thoracic cases. Based on these data, SAGES eliminated the HPB/solid organ/colon/thoracic category and, in partnership with the FC, approved staged implementation of the remaining criteria over 3 years. CONCLUSIONS The pilot study provided feasibility and generalizability evidence that allowed inclusion of appropriate defined categories for establishment of the new Advance GI/MIS fellowship criteria. We anticipate that the revised criteria will enhance the educational benefit of these fellowships.
Collapse
|
225
|
Austin K, Schoenberger H, Sesto M, Gaumnitz E, Teo Broman A, Saha S. Musculoskeletal Injuries Are Commonly Reported Among Gastroenterology Trainees: Results of a National Survey. Dig Dis Sci 2019; 64:1439-1447. [PMID: 30684073 DOI: 10.1007/s10620-019-5463-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Endoscopy-related musculoskeletal injuries are increasingly recognized among gastroenterologists. While injury rates and risk factors have been studied among practicing gastroenterologists, little is known about rates among trainees during fellowship. AIMS This study analyzes the prevalence of endoscopy-related overuse injuries and risk factors for injuries among a national sample of gastroenterology (GI) fellows. We also surveyed GI fellowship program directors and fellows about perceptions of overuse injuries during GI training. METHODS We distributed a 29-item electronic survey to GI fellows at accredited programs in the USA in April 2016. Survey items included demographic information, questions pertaining to injuries, and level of agreement on the importance of ergonomics training in GI fellowship. Additionally, we distributed a 7-item electronic survey to fellowship program directors evaluating perception of overuse injuries and prevention during fellowship training. Fisher's exact test determined factors associated with sustaining an injury. RESULTS An estimated 1509 fellows received the survey. Eleven percent (n = 165) of gastroenterology fellows completed the survey. Twenty percent reported having a musculoskeletal injury. Female gender was the only factor associated with a higher rate of reported injury (p < 0.01). The most common injuries reported were thumb and other hand-related pain (n = 28 [64%]). CONCLUSIONS Musculoskeletal injuries may affect up to 20% of GI fellows. Female fellows more frequently report injuries and may be at particularly high risk which has not been found in previously reported surveys of practicing gastroenterologists. Standardized curricula on ergonomic considerations and injury prevention are needed to enhance GI fellowship training and reduce injury rates.
Collapse
Affiliation(s)
- Kerstin Austin
- Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, USA.
| | - Haley Schoenberger
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - Mary Sesto
- Department of Hematology and Oncology, University of Wisconsin-Madison, Madison, USA
| | - Eric Gaumnitz
- Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, USA
| | - Aimee Teo Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, USA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin-Madison, Madison, USA
| |
Collapse
|
226
|
Abstract
PURPOSE OF REVIEW With the rapid development of novel cancer therapeutics and the growing number of cancer survivors, there is significant demand for cardio-oncology experts to care for these patients. As such, it has become increasingly necessary to develop formalized training in the field of cardio-oncology. This review will focus on the current state of cardio-oncology education, with recommendations for the development of dedicated cardio-oncology fellowships. RECENT FINDINGS Cardio-oncology fellowships should be affiliated with high-volume centers that have established cardio-oncology clinical and research programs with dedicated cardio-oncology faculty. Several recent publications have proposed recommendations to develop uniform cardio-oncology training standards, core curricula, and evaluation metrics. With the rapid evolution of the field and the support of various profession organizations, the number and quality of dedicated cardio-oncology fellowship programs is expected to increase significantly. The adoption of defined training requirements and evaluation standards to measure competency will be essential to ensure the legitimacy and success of the field.
Collapse
Affiliation(s)
- Michael G Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 USF Magnolia Dr., MCB-CPT, Tampa, FL, 33612-9416, USA.
| |
Collapse
|
227
|
Ramaswamy RS, Fung D, Tiwari T, Foltz G, Akinwande O, Mokkarala M, Kim S, Malone C. Factors influencing selection of an interventional radiology training program. Clin Imaging 2019; 57:30-34. [PMID: 31102780 DOI: 10.1016/j.clinimag.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 05/03/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To understand factors influencing the choice and ranking of Interventional Radiology (IR) training programs among a cohort of medical students and diagnostic radiology residents pursuing careers in IR. MATERIALS AND METHODS An IRB approved, 34 question online survey (surveymonkey.com) evaluated the impact of twenty-two different factors and demographics on IR training program selection for medical students and residents. The factors analyzed included programmatic features, location characteristics, academic reputation, program size, benefits/financial incentives, emphasis on clinical care, and future job opportunities. Comparison of Likert scale responses between medical students and residents were performed by using unpaired two-sample t-tests. RESULTS 181 (145 male, 35 female) individuals responded to the survey, 74 medical students (40.9%) and 107 residents (59.1%). Medical students and residents both selected variety of IR cases as the most important and highest rated factor when choosing an IR program. Medical students ranked availability of a mentor (p = .03), inpatient consultation service (p = .003), outpatient clinic experience (p = .003), and ICU rotation experience (p < .001) significantly higher. Residents rated job placement/accomplishments of prior fellows (p = .03) and opinion of spouse/significant others (p = .002) significantly higher than medical students. CONCLUSIONS The top rated factors are similar among medical students and residents however medical students value the clinical aspects of the program (ICU experience, inpatient consultation service, outpatient clinic) more than residents. Residents placed more value on job placement opportunities in selecting an IR program.
Collapse
Affiliation(s)
- Raja S Ramaswamy
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America.
| | - Daniel Fung
- University of Texas Houston, Department of Interventional Radiology, 6411 Fannin Street J2.254, Houston, TX 77030, United States of America
| | - Tatulya Tiwari
- Endovascular Surgery and Interventional Radiology, Department of Radiology, Lexington Veterans Affairs (VA) Medical Center, 1101 Veterans Drive, Lexington, KY 40502, United States of America
| | - Gretchen Foltz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America
| | - Olaguoke Akinwande
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America
| | - Mahati Mokkarala
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America
| | - Seung Kim
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America
| | - Christopher Malone
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, Department of Interventional Radiology, 510 S Kingshighway Blvd, CB 8131, St. Louis, MO 63139, United States of America
| |
Collapse
|
228
|
Ruddell JH, Eltorai AEM, Bakhit M, Lateef AM, Moss SF. Analysis of Accredited Gastroenterology Fellowship Internet-Available Content: Twenty-Nine Steps Toward a Better Program Website. Dig Dis Sci 2019; 64:1074-8. [PMID: 30863954 DOI: 10.1007/s10620-019-05579-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
GOAL To assess publicly available content derived from official websites of accredited gastroenterology fellowship programs, specifically evaluating data pertinent to prospective applicants. BACKGROUND The Internet provides access to key information for applicants applying to gastroenterology fellowship, particularly as competition drives applicants to apply to a large number of programs. Thus, it is important for fellowship program websites to be up to date and contain accurate and pertinent information. METHODS Twenty-nine variables, determined as important website content on the basis of prior published website analyses and from surveys of preferences, were extracted from the relevant websites of all accredited gastroenterology fellowships in the USA. Results were binary-i.e., a website either contained or did not contain each item. RESULTS A total of 178 websites were evaluated. The mean number of online content items was 14.1(± 3.2 SD) out of a possible 29 (47.1%). Program coordinator contact information, application information, and the number of current fellows were accessible on > 80% of websites. In contrast, the typical number and types of procedures performed by fellows and number of hospitals covered by fellows on call were found on < 10% of websites. Analysis revealed that 23.2% of lifestyle, 48.3% of training, and 59.6% of program variables were met. CONCLUSIONS Gastroenterology fellowship websites lacked important content. Websites had a lower mean percentage of lifestyle content compared to training and program-related items. An organized website containing relevant information may not only attract qualified applicants but also avert unnecessary email inquiries and inappropriate applications. This study may provide guidance to gastroenterology fellowship programs seeking to improve their websites for applicants.
Collapse
|
229
|
Rodríguez Socarrás M, Ciappara M, García Sanz M, Pesquera L, Carrión DM, Tortolero L, Palou Redorta J, Cózar-Olmo JM, Esteban Fuertes M, Gómez Rivas J. Current status of young urologists and residents' activity and academic training in Spain. National survey results. Actas Urol Esp 2019; 43:169-175. [PMID: 30846289 DOI: 10.1016/j.acuro.2018.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/03/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the current status of the activity and academic training of residents and young urologists in Spain. MATERIAL AND METHODS From the working group of residents and young urologists of the Spanish Association of Urology (AEU), an anonymous survey of 32 questions was designed. Its aim was to evaluate the academic activity of residents, defined by: number of communications to congresses, publications in national and international journals, clinical rotations within Spain and abroad, master's degree, Doctorate (PhD), applications to the European Board of Urology exam and language competences. The survey was sent via email and disseminated through social networks. RESULTS Ninety-one respondents were obtained; 66% affirmed not having publications in scientific journals, 67% did not perform rotations abroad. Only 21% claimed to have taken the EBU exam. Only 2% of the respondents had completed a Fellowship. Although most of them (82%) had not done so, they would be interested. However, 67% of respondents believed that the relevance of academic/research activity is from high to very high. CONCLUSIONS Our results indicate that academic activity, scientific production and publication of articles of the residents and young urologists in Spain is low. Moreover, participation in the EBU exam, the completion of a master's degree, PhD, rotations and fellowship is low. In contrast, the assessment of scientific activity is considered to be very relevant.
Collapse
Affiliation(s)
- M Rodríguez Socarrás
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Fellowship Servicio de Urología, Ospedale San Raffaele Turro, Milán, Italia; European Training Center in Endourology (ETCE); Young Academic Urologist Urotechnology group (YAU-ESUT).
| | - M Ciappara
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, Hospital Clínico San Carlos, Madrid, España
| | - M García Sanz
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, Complejo Universitario Hospitalario de León, León, España
| | - L Pesquera
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - D M Carrión
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, Hospital Universitario La Paz, Madrid, España
| | - L Tortolero
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, IMED Hospitales, Levante, España
| | | | - J M Cózar-Olmo
- Servicio de Urología, Complejo Hospitalario Universitario de Granada, Granada, España
| | - M Esteban Fuertes
- Servicio de Urología, Hospital de Parapléjicos de Toledo, Toledo, España
| | - J Gómez Rivas
- Grupo de Residentes y Jóvenes Urólogos de la Asociación Española de Urología; Servicio de Urología, Hospital Universitario La Paz, Madrid, España; Young Academic Urologist Urotechnology group (YAU-ESUT)
| |
Collapse
|
230
|
Ruddell JH, Eltorai AEM, Mark AS, Raman S, Sams CM. What's missing? An analysis of pediatric radiology fellowship website utility and recruitment potential. Pediatr Radiol 2019; 49:723-726. [PMID: 30911780 DOI: 10.1007/s00247-019-04381-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/22/2019] [Accepted: 02/10/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pediatric radiology fellowship web pages convey practical information and provide an opportunity to impress upon visitors the mission and principles that are core to the program. OBJECTIVE The goal of the study was to assess pediatric radiology fellowship program websites and identify potential areas for improvement because applications and enrollment have been steadily declining since 2013. MATERIALS AND METHODS We evaluated 41 websites of pediatric radiology fellowship programs for 17 criteria. We classified programs by region, size and separate web page status. We compared the met criteria using the Kruskal-Wallis and two-sided t-test, accounting for any unequal variances and distributions. RESULTS Of the websites evaluated, the average content score was 42.3%, meeting only 7.2±2.9 of the 17 criteria. Programs in the Northeast were associated with higher online comprehensiveness (P=0.034), as were programs with a separate website for pediatric radiology (P<0.001). We also noted a higher number of positions offered per year than there were fellows enrolled (2.73±2.3 versus 1.39±2.3; P<0.001). CONCLUSION The future of diverse pediatric radiology fellowship training opportunities is increasingly influenced by the availability and transparency of fellowship program and training attributes online. With an average content score of 42.3% across the examined fellowship websites, it is evident that there is room for improvement in the information provided by the pediatric radiology fellowship programs, particularly with respect to providing alumni information and job dispositions, listing current fellows whom applicants may contact regarding the program, and including realistic call and other work expectations of fellows.
Collapse
Affiliation(s)
- Jack H Ruddell
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Adam E M Eltorai
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Andrew S Mark
- Warren Alpert Medical School, Brown University, Providence, RI, USA.,Division of Pediatric Imaging, Department of Diagnostic Imaging, Hasbro Children's Hospital, Rhode Island Medical Imaging, Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA
| | - Sasha Raman
- Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Cassandra M Sams
- Warren Alpert Medical School, Brown University, Providence, RI, USA. .,Division of Pediatric Imaging, Department of Diagnostic Imaging, Hasbro Children's Hospital, Rhode Island Medical Imaging, Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA.
| |
Collapse
|
231
|
Urban RR, Ramzan AA, Doo DW, Sheeder J, Guntupalli SR. The perceptions of gynecologic oncology fellows on readiness for subspecialty training following OB/GYNRESIDENCY. Gynecol Oncol Rep 2019; 28:104-108. [PMID: 30997375 PMCID: PMC6451191 DOI: 10.1016/j.gore.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/23/2022] Open
Abstract
A recent survey of fellowship program directors (PD) within gynecologic oncology (GO) noted concerns regarding the abilities of incoming fellows. The objective of this study was to evaluate the perceptions of current and former fellows in gynecologic oncology of their readiness for fellowship training. A previously used survey was modified and distributed in 2016 to current and former fellows in GO. The survey explored domains of independent practice, psychomotor ability, clinical evaluation and scholarship. A standard Likert scale was employed and domains/responses were tailored to the subspecialty. A total of 150 current and recently former fellows responded to the survey, for a response rate of 38.7%. Nearly 70% of respondents reported being able to independently perform a hysterectomy when starting fellowship, and nearly 50% felt they could perform lysis of adhesions either without assistance. Although nearly 95% reported having had the opportunity to develop a plan of action for patients on labor and delivery, only 40.7% felt able to independently manage postoperative complications without assistance. Common themes that emerged in the open-ended responses pertained to self-perception of inadequate surgical skills and knowledge specific to gynecologic oncology. Although the majority of current and former fellows in gynecologic oncology report feeling prepared for fellowship, themes noted in the open-ended responses suggest a lack of confidence in surgical skills and clinical knowledge. The majority of current and former GO fellows report feeling prepared for fellowship. Discrepancies were noted between our study and results of a prior survey of fellowship directors. Open-ended responses suggested lack of confidence in surgical skills and in clinical knowledge.
Collapse
Affiliation(s)
- Renata R Urban
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Washington School of Medicine, Seattle, WA, United States of America
| | - Amin A Ramzan
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Denver, CO, United States of America
| | - David W Doo
- Fellow, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama, Birmingham, AB, United States of America
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado School of Medicine, Denver, CO, United States of America
| | - Saketh R Guntupalli
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Colorado School of Medicine, Denver, CO, United States of America
| |
Collapse
|
232
|
Abstract
PURPOSE Fellowship programs' online content plays a key role in prospective Abdominal Radiology applicants' evaluation of programs. The purpose of this study is to examine the online accessibility of Abdominal Radiology fellowships, the comprehensiveness of the program websites' content, and evaluate whether specific program characteristics are associated with differentiated website comprehensiveness. METHODS A list of 67 Abdominal Radiology fellowship programs was obtained from the Society of Abdominal Radiology (SAR) website. Each of the 65 publicly-available fellowship websites was scored for the presence of 19 binary variables related to the program's attributes and curriculum to assess informational comprehensiveness. Comprehensiveness scores were compared by program characteristics (accreditation status, region, and size) using Kruskal-Wallis and two-tailed t tests. RESULTS Mean comprehensiveness score of Abdominal Radiology fellowship websites as measured by online criteria met was 52.6% (10.0 ± 3.0/19). Application requirements and information, rotation scheduling, and program director contact were found on more than 87.5% of the 65 websites, whereas salary and benefits, social information, and alumni were listed on fewer than 33.8% (22/65) of websites. Program accreditation status, region, and size were not associated with difference in mean comprehensiveness scores. CONCLUSIONS There is a discrepancy between information commonly sought by prospective Abdominal Radiology fellowship applicants and what is available on fellowship program websites. Programs and applicants alike may benefit from programs strengthening their online material.
Collapse
Affiliation(s)
- Jack H Ruddell
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA.
| | - Zachary J Hartley-Blossom
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ankush I Bajaj
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - David Grand
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adam E M Eltorai
- Warren Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA
| |
Collapse
|
233
|
Weller R, Healy J, Hettler DL, Howe JL, Smith HM, Steckart MJ, Periyakoil VS. VA Interprofessional Fellowship in Palliative Care: 15 Years of Training Excellence. J Soc Work End Life Palliat Care 2019; 15:85-98. [PMID: 31385743 DOI: 10.1080/15524256.2019.1645797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Since 2002, the Department of Veterans Affairs (VA) has provided a unique training opportunity in palliative care at six VA medical centers. The VA Interprofessional Fellowship in Palliative Care has trained chaplains, nurses, pharmacists, physicians, psychologists, and social workers to provide clinical palliative care and to develop as leaders in the profession. This article describes the program's origin, mission, outcomes, and lessons learned.
Collapse
Affiliation(s)
- Ryan Weller
- VA Portland Health Care System , Portland , Oregon , USA
| | - Jennifer Healy
- South Texas Veterans Health Care System , San Antonio , Texas , USA
| | - Debbie L Hettler
- Department of Veterans Affairs, Office of Academic Affiliations , Washington , DC , USA
| | - Judith L Howe
- Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center , Bronx , New York , USA
| | - Heather M Smith
- Clement J. Zablocki VA Medical Center and Medical College of Wisconsin , Milwaukee , Wisconsin , USA
| | - M Jillisa Steckart
- VA Greater Los Angeles Health Care System , Los Angeles , California , USA
| | - Vyjeyanthi S Periyakoil
- Stanford University School of Medicine and Palo Alto VA Health Care System , Palo Alto , California , USA
| |
Collapse
|
234
|
Yadav RR, Ngo-Huang AT, Fu JB, Ng A, Custodio C, Bruera E. A Survey Regarding the Knowledge, Attitudes, and Beliefs of Graduates of Cancer Rehabilitation Fellowship Program. J Cancer Educ 2019; 34:402-405. [PMID: 29926435 DOI: 10.1007/s13187-018-1385-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Currently there are limited options for physiatrists to further subspecialize in cancer rehabilitation. Since 2007, few cancer rehabilitation fellowship programs have been started. There is currently absolutely no information about such training programs and their graduates. This study is the first to survey a small number of graduates from two cancer rehabilitation fellowship programs. The purpose of this study was to report characteristics, attitudes, and beliefs of cancer rehabilitation fellowship graduates. Graduates of cancer rehabilitation fellowship programs from 2008 through 2015 responded to a 26-question survey. Information collected included exposure to cancer rehabilitation prior to fellowship training, usefulness of fellowship training program, information about current practice, and suggested areas of improvement. The setting of the study is online survey. Participants were graduates of two cancer rehabilitation fellowship programs from 2008 through 2015. Participants were contacted via email about completion of an online survey and information was collected anonymously. Primary outcome measure was satisfaction of respondents with their fellowship training program in meeting the rehabilitation needs of their cancer patients. Sixteen responses, with a response rate of 89%, were recorded. Sixty-three percent of the respondents had exposure to cancer rehabilitation prior to post-graduate year 3 (PGY-3). Majority of graduates had practice involving at least 50% of care to cancer patients. Fifty percent indicated that their position was specifically created after their job interview. Career development was one of the major areas of suggested improvement in training. Graduates of cancer rehabilitation fellowship programs strongly value their training. Majority of the graduates were able to continue their career into jobs that were primarily cancer rehabilitation related. Further work needs to be done to define this subspecialty further and incorporate building practice as part of this training.
Collapse
Affiliation(s)
- Rajesh R Yadav
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA.
| | - An T Ngo-Huang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | - Jack B Fu
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | - Amy Ng
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | | | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| |
Collapse
|
235
|
Yheulon CG, Balla FM, Ernat JJ, Lin E, Davis SS. Academic inertia: Examining changes of scholarly output over time among academic minimally invasive surgeons. Am J Surg 2019; 218:813-817. [PMID: 30910131 DOI: 10.1016/j.amjsurg.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The purpose of this study is to assess how the Hirsch Index (h-index) and other academic metrics change over time for academic minimally invasive surgeons (MIS). METHODS Through the Fellowship Council's website, MIS program-directors and associate program-directors were identified in 2017 and again in 2018. Using the Scopus database, the number of publications, citations, self-citations, and h-indices were calculated. RESULTS A total of 222 surgeons were included. The median increase of publications, citations, and h-index were 4, 134, and 1, respectively. 75% of surgeons (166/222) saw their h-index increase. In 2017, 26% of surgeons (57/222) had an increase of their h-index due to self-citation. One-year later, 35% of those surgeons (20/57) no longer demonstrated that change. CONCLUSION Self-citation remains infrequent within MIS. The h-index of most surgeons will increase over one-year. Many surgeons demonstrating an increase in h-index due to self-citation will see that change eliminated over time.
Collapse
Affiliation(s)
| | - Fadi M Balla
- Department of Surgery, Kaiser Westside Medical Center, Hillsboro, OR, USA
| | - Justin J Ernat
- Department of Orthopedic Surgery, Blanchfield Army Community Hospital, Fort Campbell, KY, USA
| | - Edward Lin
- Division of General and GI Surgery, Emory University Hospital, Atlanta, GA, USA
| | - S Scott Davis
- Division of General and GI Surgery, Emory University Hospital, Atlanta, GA, USA
| |
Collapse
|
236
|
Barsoumian AE, Yun HC. Augmenting Fellow Education Through Spaced Multiple-Choice Questions. Mil Med 2019; 183:e122-e126. [PMID: 29401332 DOI: 10.1093/milmed/usx020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 10/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background The San Antonio Uniformed Services Health Education Consortium Infectious Disease Fellowship program historically included a monthly short-answer and multiple-choice quiz. The intent was to ensure medical knowledge in relevant content areas that may not be addressed through clinical rotations, such as operationally relevant infectious disease. After completion, it was discussed in a small group with faculty. Over time, faculty noted increasing dissatisfaction with the activity. Spaced interval education is useful in retention of medical knowledge and skills by medical students and residents. Its use in infectious disease fellow education has not been described. To improve the quiz experience, we assessed the introduction of spaced education curriculum in our program. Materials and Methods A pre-intervention survey was distributed to assess the monthly quiz with Likert scale and open-ended questions. A multiple-choice question spaced education curriculum was created using the Qstream(R) platform in 2011. Faculty development on question writing was conducted. Two questions were delivered every 2 d. Incorrectly and correctly answered questions were repeated after 7 and 13 d, respectively. Questions needed to be answered correctly twice to be retired. Fellow satisfaction was assessed at semi-annual fellowship reviews over 5 yr and by a one-time repeat survey. Results Pre-intervention survey of six fellows indicated dissatisfaction with the time commitment of the monthly quiz (median Likert score of 2, mean 6.5 h to complete), neutral in perceived utility, but satisfaction with knowledge retention (Likert score 4). Eighteen fellows over 5 yr participated in the spaced education curriculum. Three quizzes with 20, 39, and 48 questions were designed. Seventeen percentage of questions addressed operationally relevant topics. Fifty-nine percentage of questions were answered correctly on first attempt, improving to 93% correct answer rate at the end of the analysis. Questions were attempted 2,999 times. Fellows consistently indicated that the platform was "highly enjoyed," "beneficial," a "fun format," and "completely satisfied." Fellows additionally commented that they desired more questions and considered the platform helpful in board preparation. Formal survey data post-intervention found that the fellows were satisfied with the new approach, found it to be useful in board preparation, overall educational value, and in-line with their personal learning style (median Likert score of 4 for all queries). Fellows were satisfied with time commitment, spending a mean of 47 min on the spaced education curriculum questions per month. Conclusions Introduction of a spaced education curriculum resulted in a sustained positive learner experience for >5 yr with demonstrated mastery of material. Spaced education learning is a viable addition to augment training experience, especially in areas of curricular gaps such as operational medicine. Correct answer data may also be useful to perform Accreditation Council for Graduate Medical Education-required objective assessment of knowledge.
Collapse
Affiliation(s)
- Alice E Barsoumian
- Infectious Disease Service, Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio TX 78234
| | - Heather C Yun
- Infectious Disease Service, Department of Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, San Antonio TX 78234
| |
Collapse
|
237
|
McCallum JC, Wyers MC, Soden PA, Eidt JF, Guzman RJ, Schermerhorn ML, Chaikof EL, Hamdan AD. Vascular fellow and resident experience performing infrapopliteal revascularization with endovascular procedures and vein bypass during training. J Vasc Surg 2018; 68:1533-7. [PMID: 30360842 DOI: 10.1016/j.jvs.2018.01.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 01/25/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Endovascular aneurysm repair has led to a significant reduction in vascular trainee experience in the surgical treatment of aortic aneurysms. We sought to evaluate whether the vascular training paradigm or the "endovascular first" approach to lower extremity vascular disease has had a similar effect on trainee experience with infrapopliteal endovascular therapy and vein bypass. METHODS Deidentified data were provided by the Vascular Surgery Board on the number of procedures performed by each 2014 fellowship and residency (0 + 5) graduate during training. Data were analyzed using parametric and nonparametric methods, where appropriate. RESULTS Of 125 trainees (109 fellows, 16 residents), 33 (27%) performed 10 or fewer infrapopliteal vein bypasses and 37 (29%) performed 10 or fewer infrapopliteal endovascular procedures during their training. Eleven trainees (9%) performed 10 or fewer of both procedures. There was a positive correlation between number of infrapopliteal vein bypass and endovascular procedures performed (r = 0.19; P = .03). There was no difference between fellows and residents in the mean number of bypass operations performed during training (17.3 vs 19.1; P = .50; range, 0-53). However, residents performed more infrapopliteal endovascular procedures than fellows did (median, 29 vs 16; P = .03; range, 0-128). CONCLUSIONS More than one in four graduates of both training paradigms finish with a low number of infrapopliteal bypasses and endovascular interventions. The number of these procedures needed for proficiency is not known. Vascular surgery training programs should critically evaluate the number of infrapopliteal procedures required to achieve proficiency.
Collapse
|
238
|
Torres-de la Roche LA, Leicher L, Steljes I, Eidswick J, Larionov O, de Wilde MS, Campo R, Tanos V, De Wilde RL. Training and qualification in gynecological minimal access surgery: A systematic review. Best Pract Res Clin Obstet Gynaecol 2019; 59:2-11. [PMID: 30857979 DOI: 10.1016/j.bpobgyn.2019.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023]
Abstract
Minimally invasive surgery demands specific endoscopic psychomotor skills that are usually acquired outside the operating theatre. We present the results of a systematic analysis to identify how simulation is used during training and qualification in minimal access surgery to improve gynecologist's surgical skills. We found that despite the availability of simulation tools along with methods for training and testing specific endoscopic psychomotor and technical skills, there is no clear evidence of the superiority of one tool or method over the others in skill acquisition. However, prospective studies show that well-guided training courses combined with different trainers and methods improve significantly surgeon's laparoscopic skills and suturing ability, which are unforgettable over time. However, this proficiency could deteriorate over time when it is solely learned and executed on simulation trainers. Structured curricula including theory, simulation, and live-surgery seem to be the best option for trainees. More research in this field is needed.
Collapse
|
239
|
Wang LC, Mittal AG, Puttmann K, Janzen N, Palmer LS, Yerkes EB, Ryan SL, Gonzales ET, Roth DR, Koh CJ. The changing gender landscape of pediatric urology fellowship: results from a survey of fellows and recent graduates. J Pediatr Urol 2019; 15:51-57. [PMID: 30340928 DOI: 10.1016/j.jpurol.2018.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Women are entering the subspecialty of pediatric urology at an accelerated rate. Gender differences affecting fellowship and job selection have been identified in other fields of medicine. OBJECTIVE The objective of this study was to understand gender differences in pediatric urology fellowship and job selection and how they may affect the workforce. STUDY DESIGN A 47-question electronic survey consisting of questions regarding demographics, residency training, and factors influencing fellowship and job selection was distributed to current fellows and recent graduates in pediatric urology in May 2017. RESULTS A total of 111 recent and current fellows were contacted, and 72% completed the survey (55% female [F] and 45% male [M]; 61% current fellows and 39% recent fellows). Respondents rated factors important in choosing pediatric urology on a scale of 1-5 (1, not important and 5, extremely important), and the top three for both genders were 1-working with children, 2-influential mentors, and 3-bread and butter cases such as inguinal orchiopexy. During residency, 93% of respondents reported having influential mentors in pediatric urology. However, mentorship was more important in fellowship choice for males than females (3.6 F, 4.1 M; P-value = 0.048), and 45% reported having only male mentors. Rating factors important in job choice on a scale of 1-5, respondents reported the top factors as 1-rapport with partners/mentorship (4.5), 2-geography/family preferences (4.3), and 3-participation in mentoring/teaching (3.8). Although most job selection criteria were rated similarly between genders, females rated call schedule higher than males (3.5 F, 2.9 M, P-value = 0.009). Although most females and males (79% of F, 78% of M, P-value = 0.868) sought primarily academic positions, a smaller proportion of females accepted academic positions (52% of F, 72% of M, P-value 0.26), and females reported lower satisfaction regarding the availability of jobs on a scale of 1-5 (1, very dissatisfied and 5, very satisfied; 3.1 F, 3.7 M; P-value = 0.034), particularly in academic positions (3.1 F, 3.7 M; P-value = 0.06). This difference was more pronounced in current fellows than recent graduates and may represent a worsening trend. CONCLUSION Although significant gender differences in fellowship and job selection may exist in other fields, we found that women and men choose pediatric urology fellowships and jobs using similar criteria, which include work-life balance. Gender differences exist in the influence of mentors, indicating a need for more female mentors. While men and women sought similar types of jobs, women were less satisfied with the availability of jobs, particularly academic jobs, than men, which warrants further investigation.
Collapse
Affiliation(s)
- L C Wang
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA.
| | - A G Mittal
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - K Puttmann
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - N Janzen
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - L S Palmer
- Department of Pediatric Urology, Cohen Children's Medical Center of New York, New Hyde Park NY, USA
| | - E B Yerkes
- Division of Urology, Lurie's Children's Hospital, Chicago IL, USA
| | - S L Ryan
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - E T Gonzales
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - D R Roth
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| | - C J Koh
- Division of Pediatric Urology, Texas Children's Hospital, Houston TX, USA
| |
Collapse
|
240
|
Weingarten N, Issa N, Posluszny J. Fellow-led SICU morbidity and mortality conferences address patient safety, quality improvement, interprofessional cooperation and ACGME milestones. Am J Surg 2019; 219:309-315. [PMID: 30717884 DOI: 10.1016/j.amjsurg.2019.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/07/2018] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Morbidity and mortality conferences (MMCs) promote patient safety, spur quality improvement (QI) projects, and enhance interprofessional cooperation. The use of MMCs to address the Accreditation Council for Graduate Medical Education's (ACGME's) six core competencies and specialty-specific milestones for surgical critical care (SCC) fellows has yet to be explored. METHODS We developed a monthly, interprofessional, case-based MMC program managed by SCC fellows. We assessed participants' experiences through post-conference surveys and semi-structured interviews. RESULTS After nine conferences, 95.1% of participants (n = 143) agree or strongly agree that the MMC improved their knowledge and clinical assessment skills. The MMC spurred two QI projects, increased interprofessional cooperation, and addressed all six ACGME core competencies and 16 specialty-specific milestones. CONCLUSIONS Interprofessional, case-based MMCs are an effective educational tool for SCC fellowship programs. They promote patient safety, QI, and interprofessional cooperation, and address ACGME core competencies and specialty-specific milestones for SCC fellows.
Collapse
Affiliation(s)
- Noah Weingarten
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL, 60611, USA.
| | - Nabil Issa
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Surgical Critical Care, 676 N. Saint Clair Street, Suite 650, Chicago, Illinois 60611, USA
| | - Joseph Posluszny
- Northwestern University Feinberg School of Medicine, Department of Surgery, Division of Trauma and Surgical Critical Care, 676 N. Saint Clair Street, Suite 650, Chicago, Illinois 60611, USA
| |
Collapse
|
241
|
Rozenberg A, Kenneally BE, Abraham JA, Strogus K, Roedl JB, Morrison WB, Zoga AC. Second opinions in orthopedic oncology imaging: can fellowship training reduce clinically significant discrepancies? Skeletal Radiol 2019; 48:143-7. [PMID: 30003278 DOI: 10.1007/s00256-018-3024-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/12/2018] [Accepted: 06/28/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine factors that lead to significant discrepancies in second-opinion consultation of orthopedic oncology patients, and particularly if musculoskeletal fellowship training can decrease clinically significant discrepancies. METHODS A PACS database was queried for secondary reads on outside cross-sectional imaging studies, as requested by orthopedic oncology from 2014 to 2017. Comparison of original and secondary reports was performed using a published seven-point scale that defines clinically significant discrepancies. An online search was performed for each original radiologist to record if a fellowship in musculoskeletal imaging was completed. Additionally, years of post-residency experience, number of Medicare part B patients billed per year (marker of practice volume), and average hierarchical condition category for each radiologist (marker of practice complexity) was recorded. RESULTS A total of 571 patients met the inclusion criteria, with 184 cases initially interpreted by an outside fellowship trained musculoskeletal (MSK) radiologist and 387 cases initially interpreted by a non-MSK trained radiologist. The rate of clinically significant discrepancy was 9.2% when initially interpreted by MSK radiologists compared with 27.9% when initially performed by non-MSK radiologists (p < 0.05). After adjustment by both patient characteristics and radiologist characteristics, the likelihood of clinically significant discrepancies was greater for initial interpretations by non-MSK radiologists compared with MSK radiologists (OR = 1.36; 95% CI = 1.23-2.49). CONCLUSION In orthopedic oncology patients, the rate of clinically significant discrepancies was significantly higher when initially interpreted by non-MSK radiologists compared with MSK radiologists. The lower rate of clinically significant discrepancies demonstrates that subspecialty training may direct more appropriate diagnosis and treatment.
Collapse
|
242
|
Abstract
Purpose To analyze the growth trends in ophthalmic education in Iran since 1979, and to discuss their implications on the profession. Methods This comprehensive national study was performed by the Academy of Medical Sciences of I.R. Iran. The data were gathered from the Specialty Training Council of the Ministry of Health and from the Medical Council of Iran. Results Our analysis revealed ten important current growth trends and seven future trends and implications. Between 1979-80 and 2015-16, the number of residents annually admitted to ophthalmology increased from 21 to 84 and related fellowships and from 0 to 34. The number of ophthalmologists graduating in the country increased from 21 (45%) in 1979 to 69 (98%) in 2015. The ratio of ophthalmologists per 100,000 people averaged 1.91 in 1979 and 3.00 in 2016. Considering migrant and retired ophthalmologists, there are approximately 2400 active ophthalmologists in Iran. In 1979, there was one active ophthalmologist per 52,112 people; in 2014, there was one per 33,333 people. This represents a per capita increase of 57%. Since 1979, the number of active ophthalmologists has increased by 234%. The number of active women ophthalmologists has increased by more than 600%, from 65 (9%) in 1979 to 470 (20%) in 2016. Conclusion Equitable geographic distribution and balanced combination of ophthalmologists (women/men and specialists/fellowships) are necessary to optimize community eye health. We propose further studies on the effects of fellowship training growth and work patterns of female and male ophthalmologists.
Collapse
Affiliation(s)
- Shima Tabatabai
- Medical Education Group, Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
243
|
Sinclair M, Raimo J, Wong K, Kline M, Friedman K. A Novel Curriculum to Prepare Internal Medicine Residents for Fellowship Interviews. J Med Educ Curric Dev 2019; 6:2382120519855939. [PMID: 31259253 PMCID: PMC6585249 DOI: 10.1177/2382120519855939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Applications to the Fellowship Match through the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high. Data regarding the preparedness of medical residents who go through the interview process is limited. OBJECTIVE To assess whether the implementation of an interview curriculum could improve medical resident preparedness for and performance during fellowship interviews. METHODS All third-year internal medicine residents (N = 18) at the Zucker School of Medicine at Hofstra/Northwell (Northwell) applying to subspecialty fellowship participated in an interview curriculum that comprised a didactic session and an Objective Structured Teaching Exercise (OSTE). Participants were surveyed on preparedness before and after the curriculum and medical residents and faculty were surveyed on medical resident performance after their OSTE and after their Northwell fellowship interview. RESULTS Out of the total possible number of participants, 16 (89%) were included in our analysis. Pre and post-test statistical differences in survey responses were evaluated using the Wilcoxon signed rank test. Medical resident preparedness and resident perceived performance increased in all measured categories, including overall preparedness (P = .001) and overall interview skills (P = .008). No significant change in faculty-rated resident performance was observed. CONCLUSION The development and institution of a formal interview curriculum improved medical resident preparedness and perceived performance. However, this significant improvement seen between medical resident pre and post surveys did not translate to improvement between faculty pre and post surveys. Future studies should look at fellowship match rates to objectively assess the impact of the curriculum.
Collapse
Affiliation(s)
- Matthew Sinclair
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - John Raimo
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Kelvin Wong
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Myriam Kline
- Biostatistics Unit, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Karen Friedman
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| |
Collapse
|
244
|
Yadav RR, Ngo-Huang AT, Ng A, Fu JB, Custodio C, Wisotzky E, Mitra R, Bruera E. Characteristics of Cancer Rehabilitation Fellowship Training Programs in the USA. J Cancer Educ 2018; 33:1364-1367. [PMID: 29725987 PMCID: PMC8019156 DOI: 10.1007/s13187-018-1371-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Cancer rehabilitation is emerging as a specialized field within Physical Medicine and Rehabilitation. The purpose of this systemic review is to summarize the various cancer rehabilitation fellowship programs in the USA and the scope of training in this discipline. Currently, four institutions offer such a training program. All of the fellowship directors were contacted about characteristics of their programs. The oldest program has been in existence since 2007. All of these programs are 1 year in duration and have between one and two fellowship positions annually. There have been total of 29 graduates as of July 2017. With regard to cancer rehabilitation care delivery model, all four centers reported inpatient consult teams and outpatient rehabilitation. Outpatient experience included electrodiagnosis, botulin toxin, and ultrasound-guided injections. Three of the four programs also reported the presence of an acute inpatient cancer rehabilitation service. A number of clinical rotations are available at each of the four programs with considerable variation. Comprehensive educational efforts are present in all programs with varying expectations for research.
Collapse
Affiliation(s)
- Rajesh R Yadav
- Section of Physical Medicine and Rehabilitation, Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA.
| | - An T Ngo-Huang
- Section of Physical Medicine and Rehabilitation, Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | - Amy Ng
- Section of Physical Medicine and Rehabilitation, Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | - Jack B Fu
- Section of Physical Medicine and Rehabilitation, Department of Palliative Care, Rehabilitation and Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe, Unit 1414, Houston, TX, 77030, USA
| | | | - Eric Wisotzky
- MedStar Health Research Institute, Hyattsville, MD, 20783, USA
| | - Raj Mitra
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Eduardo Bruera
- University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
245
|
MacPherson KL, Shepherd M, Everett JC, Fritsch A, Whitman JM, Dunleavy K. Perceptions of the professional and personal impact of hybrid fellowship training: a qualitative study. J Man Manip Ther 2018; 27:99-108. [PMID: 30935336 DOI: 10.1080/10669817.2018.1542850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES This study aimed to elucidate graduate perceptions of how fellowship training impacted their post-training professional and personal lives. METHODS Interviews were conducted with 13 graduates of a hybrid (e.g. blended-learning) fellowship program. All participants were at least 1 year post completion of fellowship to limit recall bias and allow for post-training personal and professional development. Qualitative analysis was performed on interview transcriptions using directed content analysis with two coders other than the interviewers, followed by discussion until agreement was reached if there were disputes related to coding analysis. If needed, arbitration was provided from one of two interviewers. RESULTS Analysis revealed three primary constructs of post-fellowship impact: practical, social, and personal. Practical subthemes were centric to care delivery. Social subthemes extended to intra, inter, and non-professional connections. Personal subthemes noted professional and cognitive evolution. DISCUSSION Participants clearly described impact extending well beyond day-to-day practice suggesting that fellowship impacted the whole person versus sole practitioner. This study may impact program structure and content inclusion for fellowship programs as well as providing support for fellows in training.
Collapse
Affiliation(s)
- Kevin L MacPherson
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Evidence In Motion Institutes for Health Professions , Louisville , KY , USA
| | - Mark Shepherd
- b Evidence In Motion Institutes for Health Professions , Louisville , KY , USA.,c Department of Physical Therapy , South College , Knoxville , TN , USA
| | - Jamie Childs Everett
- b Evidence In Motion Institutes for Health Professions , Louisville , KY , USA.,d Institute of Clinical Excellence , Windsor , CO , USA.,e Physio Sport & Spine , Cheyenne , WY , USA
| | - Adam Fritsch
- b Evidence In Motion Institutes for Health Professions , Louisville , KY , USA.,f Athletico Physical Therapy , Crystal Lake , IL , USA
| | - J M Whitman
- b Evidence In Motion Institutes for Health Professions , Louisville , KY , USA
| | - Kim Dunleavy
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA
| |
Collapse
|
246
|
Groves DK, Altieri MS, Sullivan B, Yang J, Talamini MA, Pryor AD. The Presence of an Advanced Gastrointestinal (GI)/Minimally Invasive Surgery (MIS) Fellowship Program Does Not Impact Short-Term Patient Outcomes Following Fundoplication or Esophagomyotomy. J Gastrointest Surg 2018; 22:1870-1880. [PMID: 29980972 DOI: 10.1007/s11605-018-3704-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/25/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The current surgical landscape reflects a continual trend towards sub-specialization, evidenced by an increasing number of US surgeons who pursue fellowship training after residency. Despite this growing trend, however, the effect of advanced gastrointestinal (GI)/minimally invasive surgery (MIS) fellowship programs on patient outcomes following foregut/esophageal operations remains unclear. This study looks at two representative foregut surgeries (laparoscopic fundoplication and esophagomyotomy) performed in New York State (NYS), comparing hospitals which do and do not possess a GI/MIS fellowship program, to examine the effect of such a program on perioperative outcomes. We also aimed to identify any patient or hospital factors which might influence perioperative outcomes. METHODS The SPARCS database was examined for all patients who underwent a foregut procedure (specifically, either an esophagomyotomy or a laparoscopic fundoplication) between 2012 and 2014. We compared the following outcomes between institutions with and without a GI/MIS fellowship program: 30-day readmission, hospital length of stay (LOS), and development of any major complication. RESULTS There were 3175 foregut procedures recorded from 2012 to 2014. Just below one third (n = 1041; 32.8%) were performed in hospitals possessing a GI/MIS fellowship program. Among our entire included study population, 154 patients (4.85%) had a single 30-day readmission, with no observed difference in readmission between hospitals with and without a GI/MIS fellowship program, even after controlling for potential confounding factors (p = 0.6406 and p = 0.2511, respectively). Additionally, when controlling for potential confounders, the presence/absence of a GI/MIS fellowship program was found to have no association with risk of having a major complication (p = 0.1163) or LOS (p = 0.7562). Our study revealed that postoperative outcomes were significantly influenced by patient race and payment method. Asians and Medicare patients had the highest risk of suffering a severe complication (10.00 and 7.44%; p = 0.0311 and p = 0.0036, respectively)-with race retaining significance even after adjusting for potential confounders (p = 0.0276). Asians and uninsured patients demonstrated the highest readmission rates (15.00 and 12.50%; p = 0.0129 and p = 0.0012, respectively)-with both race and payment method retaining significance after adjustment (p = 0.0362 and p = 0.0257, respectively). Lastly, payment method was significantly associated with postoperative LOS (p < 0.0001), with Medicaid patients experiencing the longest LOS (mean 3.99 days) and those with commercial insurance experiencing the shortest (mean 1.66 days), a relationship which retained significance even after adjusting for potential confounders (p < 0.0001). CONCLUSION The presence of a GI/MIS fellowship program does not impact short-term patient outcomes following laparoscopic fundoplication or esophagomyotomy (two representative foregut procedures). Presence of such a fellowship should not play a role in choosing a surgeon. Additionally, in these foregut procedures, patient race (particularly Asian race) and payment method were found to be independently associated with postoperative outcomes, including postoperative LOS.
Collapse
Affiliation(s)
- Donald K Groves
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA.
| | - Maria S Altieri
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Brianne Sullivan
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Jie Yang
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Mark A Talamini
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Aurora D Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
247
|
Pillai G, Chibale K, Constable EC, Keller AN, Gutierrez MM, Mirza F, Sengstag C, Masimirembwa C, Denti P, Maartens G, Ramsay M, Ogutu B, Makonnen E, Gordon R, Ferreira CG, Goldbaum FA, Degrave WMS, Spector J, Tadmor B, Kaiser HJ. The Next Generation Scientist program: capacity-building for future scientific leaders in low- and middle-income countries. BMC Med Educ 2018; 18:233. [PMID: 30305069 PMCID: PMC6180641 DOI: 10.1186/s12909-018-1331-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 09/21/2018] [Indexed: 05/08/2023]
Abstract
BACKGROUND Scientific and professional development opportunities for early career scientists in low- and middle- income countries (LMICs) are limited and not consistent. There is a disproportionately low number of biomedical and clinical researchers in LMIC's relative to their high burden of disease, a disparity that is aggravated by emigration of up to 70% of scientists from their countries of birth for education and employment elsewhere. To help address this need, a novel University-accredited, immersive fellowship program was established by a large public-academic-private network. We sought to describe the program and summarize progress and lessons learned over its first 7-years. METHODS Hallmarks of the program are a structured learning curriculum and bespoke research activities tailored to the needs of each fellow. Research projects expose the scientists to state-of-the-art methodologies and leading experts in their fields while also ensuring that learnings are implementable within their home infrastructure. Fellows run seminars on drug discovery and development that reinforce themes of scientific leadership and teamwork together with practical modules on addressing healthcare challenges within their local systems. Industry mentors achieve mutual learning to better understand healthcare needs in traditionally underserved settings. We evaluated the impact of the program through an online survey of participants and by assessing research output. RESULTS More than 140 scientists and clinicians from 25 countries participated over the 7-year period. Evaluation revealed strong evidence of knowledge and skills transfer, and beneficial self-reported impact on fellow's research output and career trajectories. Examples of program impact included completion of post-graduate qualifications; establishment and implementation of good laboratory- and clinical- practice mechanisms; and becoming lead investigators in local programs. There was a high retention of fellows in their home countries (> 75%) and an enduring professional network among the fellows and their mentors. CONCLUSIONS Our experience demonstrates an example for how multi-sectoral partners can contribute to scientific and professional development of researchers in LMICs and supports the idea that capacity-building efforts should be tailored to the specific needs of beneficiaries to be maximally effective. Lessons learned may be applied to the design and conduct of other programs to strengthen science ecosystems in LMICs.
Collapse
Affiliation(s)
- Goonaseelan Pillai
- CP+ Associates GmbH, Basel, Switzerland
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kelly Chibale
- Drug Discovery and Development Centre (H3D), South African Medical Research Council Drug Discovery and Development Research Unit and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | | | | | | | | | | | | | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience and Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bernhards Ogutu
- University of Strathmore and Kenya Medical Research Institute, Nairobi, Kenya
| | - Eyasu Makonnen
- Center For Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | |
Collapse
|
248
|
Yheulon CG, Balla FM, Patel AD, Stetler JL, Lin E, Davis SS. Publication patterns and the impact of self-citation among minimally invasive surgery fellowships. Am J Surg 2018; 217:346-349. [PMID: 30257788 DOI: 10.1016/j.amjsurg.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/23/2018] [Accepted: 09/17/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The h-index is a widely utilized academic metric that measures both productivity and citation impact. The purpose of this study is to define the impact of self-citation among minimally invasive surgery (MIS) fellowship program directors. METHODS Through the Fellowship Council's website, all program directors and associate program directors from the 148 MIS fellowship programs were identified. Using the Scopus database, we calculated the number of publications, citations, self-citations, and h-index for each surgeon. RESULTS A total of 274 surgeons were identified. The mean number±SD of publications, citations, and h-index for the cohort were 60.5 ± 77.2, 1765 ± 4024, and 16.0 ± 15.0, respectively. The self-citation rate for the entire cohort was 3.23%. Excluding self-citations reduces the mean number of citations to 1708 ± 3887 and h-index to 15.8 ± 14.6. The h-index remained unchanged for 77% (210/274) of surgeons. Only 5% (15/274) of surgeons had a change in h-index of greater than one integer and no surgeon had a change greater than three integers. CONCLUSION Self-citation is infrequent and has a minimal impact on the academic profile of program directors of MIS fellowships.
Collapse
Affiliation(s)
| | - Fadi M Balla
- Division of General and GI Surgery, Emory University Hospital, United States
| | - Ankit D Patel
- Division of General and GI Surgery, Emory University Hospital, United States
| | - Jamil L Stetler
- Division of General and GI Surgery, Emory University Hospital, United States
| | - Edward Lin
- Division of General and GI Surgery, Emory University Hospital, United States
| | - S Scott Davis
- Division of General and GI Surgery, Emory University Hospital, United States
| |
Collapse
|
249
|
Ilczyszyn A, Lynn W, Rasheed S, Davids J, Aguilo R, Agrawal S. Bariatric fellowship positively influences early outcomes for laparoscopic Roux-en-Y gastric bypass surgery over seven years of independent practice. Ann R Coll Surg Engl 2018; 100:1-5. [PMID: 30112939 PMCID: PMC6204496 DOI: 10.1308/rcsann.2018.0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2018] [Indexed: 02/03/2023] Open
Abstract
Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically demanding and has an associated learning curve. We published previously that bariatric fellowship reduces the learning curve of primary LRYGB and improves patient outcomes after one year of independent practice. However, the long-term effect of fellowship is unknown. We therefore aimed to compare the 30-day outcomes of LRYGB between the first year of a surgeon's independent practice with the subsequent six years. Materials and methods A prospective database of patients undergoing primary LRYGB under a single surgeon from March 2010 until February 2017 was analysed. Two groups were studied: first year (< 1 year) and the subsequent six years (≥ 1 year) of independent practice. Patient demographics, length of hospital stay, conversion to open surgery, perioperative complications and mortality were compared. Results Among 279 eligible patients, 74 (26.5%) were in the < 1 year group and 205 (73.5%) in ≥ 1 year group. The preoperative risk scores, American Society of Anesthesiologists (ASA) grade, P = 0.00; obesity surgery mortality risk score (OS-MRS), P = 0.04) were significantly higher in ≥ 1 year group. There was no significant difference in perioperative outcomes (length of stay, P = 0.38; total complications, P = 0.20; readmissions, P = 1.00; reoperations, P = 0.60) between the two groups. Conclusions Bariatric fellowship reduces the learning curve for LRYGB and helps to achieve excellent outcomes in the first and subsequent years of independent practice. The higher risk profile of ≥ 1 year group did not equate to an increase in complications, suggesting that experience and standardisation may help in handling complex cases. To our knowledge, this represents the only such study in the literature.
Collapse
Affiliation(s)
- A Ilczyszyn
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| | - W Lynn
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| | - S Rasheed
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| | - J Davids
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| | - R Aguilo
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| | - S Agrawal
- Department of Upper Gastrointestinal and Bariatric Surgery, Homerton University Hospital, London, UK
| |
Collapse
|
250
|
Abstract
The availability of detailed and high-quality food consumption data collected at an individual level is essential for assessing the exposure to potential risks in the food chain. During the years 2012-2016, the Dutch National Food Consumption Survey was conducted in the Netherlands as part of the EU Menu survey, following the EFSA 2009 guidance on 'General principles for the collection of national food consumption data in the view of a pan-European dietary survey'. Complete results were obtained for 4,313 persons aged 1-79 years (response rate 65%). The work programme proposed to the European Food Risk Assessment (EU-FORA) Fellow included FoodEx2 mapping of the Dutch food consumption data and preparing the final scientific report for EFSA as well as analysing habitual intake of nutrients using the SPADE programme. Further activities were added, such as performing a literature search as to the validity and usability of mobile applications for collecting food consumption data and exploring methods for estimating added-sugar/free-sugar intake.
Collapse
|